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| Here we go |
1) Community health project framework
The tech team provided us with a review of the
project framework we were introduced to during PST1. This framework is intended
on helping us fulfill Peace Corps’ 3 main health sector goals by providing
concrete numerical objectives paired with carefully defined indicators. We are
told to “start with the end in mind” when planning projects; that is, we must
always design projects that will directly fulfill the objectives and overall
goals.
The three main goals of community health:
Goal 1-Communities will improve their ability to
prevent and treat malaria
Goal 2-Communities will adopt behaviors and practices
that contribute to overall maternal and infant health
Goal 3-Community members will adopt water and
sanitation hygiene practices and behaviors resulting in improved health
An
example of an objective for the 1st goal:
-By
the end of 2018, 97, 840 community members will increase their access to
malaria prevention goods and services and will adopt appropriate malaria
prevention and treatment seeking behaviors.
Each
objective is
·
accompanied by a
list of projects that will enable volunteers to collectively move towards
fulfilling that objective. For example: trainings, workshops, and distribution
of insecticide-treated bed nets…
·
accompanied by a
number of output indicators, which enable volunteers to measure the scope of
their impact. For example, a volunteer might record the number of
insecticide-treated bed nets purchased by or delivered to her community.
·
accompanied by a
number of outcome indicators; the data yielded will bring PCVs that much closer
to reaching the objective. For example, a volunteer might record the number of
people who slept under an insecticide-treated bed nets last night.
I think the project framework is exciting for several
reasons.
1) The indicators used are standard indicators, which
means that NGOs and governments the world over are using the same indicators to
measure progress. They give Peace Corps and its work credibility as an
international actor in improving community health.
2) The framework—its goals, objectives, and
indicators—hold Peace Corps Senegal and its volunteers accountable for the work
they do. We want to know whether we are effective, whether we are actually
making a SMART (Specific, Measurable, Attainable, Reachable, and Time-bound)
difference.
3) It can serve as a guide and tool for volunteers
designing new projects.
Projects are designed as follows:
Inputs-->Activities-->Outputs-->Outcomes-->Impacts
Concrete example: by teaching mothers how to cook nutritious meals for their children, we will be working towards achieving objective 2.2: “By the end of 2018, 1440 women will adopt at least one infant and young child feeding practices resulting in improved nutritional status”.
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| A well-fed pair in village |
Say we want to teach mothers how to make cereamine, a
nutritionally dense porridge, for their infants and young children.
·
Inputs include
time, people, materials
ex: counterpart, chairs, mats, ingredients for
nutritious meal cooking demonstration, mothers and their infants
·
Activities
ex: training on how to make cereamine, a nutritionally
dense porridge
·
Outputs
ex: number of women receiving the training on how to make the porridge
·
Outcomes
ex: number of women who can demonstrate the ability to make the porridge
It’s good to note the difference between outputs and outcomes; just because 20 women attended the training, doesn’t
necessarily mean that they will be making the porridge on a regular basis. I,
for one, used to conflate the two.
2) Recording, Monitoring, and Evaluation Tools
We had a couple of great session on the importance of
taking thorough surveys before initiating any project in order to assess
community need, strengths, and weaknesses. For instance, you don’t want to put
a great amount of time and resources into teaching your village women how to
make cereamine if there’s no malnutrition in your area.
Designing and conducting a survey:
·
Think about your
objectives
-what kind of
information do you want to gather
-remember data must
be relevant to the project framework
-quantitative or
qualitative data?
-practice/behavior is
best assessed through observation and qualitative data collection
·
Choose your
demographic characteristic
-employment status,
gender, ethnic/language group, age, sex…?
·
Plan, plan, plan
-how (interviews,
observation)?
-who (sample type, work
partners)?
Set a deadline and a schedule!
·
Write out your
survey questions and translate your survey questions
-get help from a
language instructor as needed
-test out your
questions on someone first, to make sure they are culturally appropriate and to
make sure they make sense
·
Record your data
-medium (excel
sheet, pre-drawn sheets)?
·
Control for
quality
-are participants’ answers
influenced by [your counterpart’s presence, for example]?
-do your
participants understand the questions?
-is the order of
the questions influencing answers?
-will people be
more responsive to indirect questions?
-observe and use
your judgment
·
Construct an
action plan based on answers
-what does my
community know/not know?
-where can I make an
impact?
Once I get back to village, I’d like to start designing
and conducting a series of surveys. I’m not sure where to start, though.
Malaria or WASH?
3) Malaria
Fun facts:
-Severe malaria can sometimes cause an infected
person’s eyes to turn yellow.
-Many people get malaria at the end of the rainy
season—in November or October—because they stop sleeping under their nets: “no
more rains, no more mosquitoes”. Wrong.
-People who don’t sleep under their nets every night
have many reasons for not doing so. One of those reasons: “nets don’t fit the
room well, or the shape isn’t good” (according to a survey by Networks).
-Pregnant women are more vulnerable to Malaria, due
to changes in their immune system. Apparently, the placenta is also a prime
hiding spot for parasites, since it’s so rich in nutrients and oxygen. This is
all bad new for both the woman and her fetus.
We had a particularly
interesting session with a 5th (!) year volunteer in the south, who
has been working on applied malaria projects. He is deeply involved in bridging
the gap between Senegalese health services and his sick community members. The
bottom line: the burden of illness is unequal in Senegal; opportunities for
seeking out and acquiring health services are not equal either.
“Invisible cases” often slip
through the system. Sometimes, people are too far away from their nearest
health structure, and don’t seek out treatment at all. They may get better on
their own, or not. Sometimes, their lack of confidence in the health system
discourages them from going: they doubt that the medication will be available,
or they have poor rapport with health care providers. In my own experience, I notice
that my ICP tends to take on a very patronizing and dismissive attitude when
interacting with his patients.
“Lost cases” are also
frequent. These are patients with malaria who do make it to a health structure,
but whose diagnosis cannot be confirmed. Senegal is often subject to medical
stock-outs or breaks. Sometimes, RDT (Rapid Diagnosis Tests) are unavailable.
Instead, they are diagnosed with diarrhea or respiratory illnesses, which have
overlapping symptoms with malaria.
So: can we actually know the
frequency and burden of malaria?
As this gap between
resources and people narrows, the recorded incidence of malaria may very well
increase. This is tricky: it does not necessarily mean we’re not making progress
in preventing new malaria cases; in fact, the actual prevalence of malaria
cases may very well stay the same or even decrease.
Numbers are always stickier
than we think.
More to come...
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| Home, sweet home |
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